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Efficacy of minimally invasive distal gastrectomy for elderly patients with clinical stage I/IIA gastric cancer: a propensity-score matched analysis

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Abstract

Background

Phase III trials have shown the non-inferiority of minimally invasive distal gastrectomy (MIDG) comparison with open distal gastrectomy (ODG) in patients with gastric cancer; however, it remains unclear whether MIDG is also effective in the elderly. This study aimed to clarify the efficacy of MIDG in elderly gastric cancer patients.

Patients and methods

This study included 316 patients older than 75 years with clinical stage I/IIA gastric cancer who underwent distal gastrectomy from August 2008 to December 2016 at the Shizuoka Cancer Centre. The long-term outcomes between MIDG and ODG were compared after propensity score matching.

Results

After propensity score matching, there were 97 patients each in the MIDG and ODG groups, with an improved balance of confounding factors between the two groups. MIDG was associated with significantly longer operative time and a lower level of blood loss than ODG. The incidence of complications was comparable between the two groups. Survival outcomes were better in the MIDG group than in the ODG group (overall survival; P = 0.034, relapse-free survival; P = 0.027). In the multivariable analysis, ODG [hazard ratio (HR) 1.971, P = 0.046], being 80 years or older (HR 2.285, P = 0.018), male sex (HR 2.428, 95% P = 0.024), and poor physical status (HR 2.324, P = 0.022) were identified as independent prognostic factors for overall survival.

Conclusions

We found that MIDG showed better efficacy than ODG in elderly gastric cancer patients. MIDG is an acceptable option for elderly patients.

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Funding

This study did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Makoto Hikage, Keiichi Fujiya, Satoshi Kamiya, Yutaka Tanizawa, Etsuro Bando & Masanori Terashima

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  1. Makoto Hikage
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  2. Keiichi Fujiya
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Correspondence to Masanori Terashima.

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Disclosures

Terashima has received personal fees from Taiho, Chugai, Ono, Bristol-Myers Squibb, Yakult, Takeda, Eli Lilly, Pfizer and Daiichi Sankyo, outside the submitted work. Hikage, Fujiya, Kamiya, Tanizawa, and Bando have no conflicts of interest or financial ties to disclose.

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Hikage, M., Fujiya, K., Kamiya, S. et al. Efficacy of minimally invasive distal gastrectomy for elderly patients with clinical stage I/IIA gastric cancer: a propensity-score matched analysis. Surg Endosc 35, 7082–7093 (2021). https://doi.org/10.1007/s00464-020-08224-w

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